The emergence and evolution of digital intelligent technology has profoundly influenced the development of minimally invasive research-oriented hepatobiliary and pancreatic surgery discipline. Over various periods, our team has always adhered to the principle of "being oriented by clinical issues and driven by clinical needs", continuously carried out innovative research across interdisciplinary boundaries, propelling the evolution of digital intelligent technology. Spanning over two decades, this journey includes the progression from digital virtual human, three-dimensional visualization, molecular fluorescence imaging, augmented reality and mixed reality, artificial intelligence, to the realm of human visualization meta-universe. This evolution facilitates the shift from two-dimensional empirical diagnoses of hepatobiliary and pancreatic surgical diseases to deep learning intelligent diagnostics, the transition from morphology-based tumor diagnoses to molecular imaging-based diagnostics, and from conventional empirical surgery to intelligent navigation surgery. The authors provide a comprehensive review of our developmental process and achievements within the realm of digital intelligent diagnostic and therapeutic technologies, with the aims to promote the development and application of digital intelligent medicine.

As 2021 is known as the “first year of the metaverse”, the concept of metaverse is promoting a multi-field innovation revolution on a global scale. The new experiences and technologies it brings are expected to provide solutions for the difficulties in the field of human visualization surgery in disease diagnosis, preoperative planning, surgical treatment, medical education, health management and patient experience. This opens up opportunities for the next wave of disruptive technology innovation. This paper proposes a new concept of “human visualization metaverse”, and summarizes its innovative application, future development direction and challenges to promote the research and development of human visualization metaverse,and to explore the application potential of metaverse technology in the field of surgery to advance the research and development of the metaverse for human visualization.

As 2021 is known as the “first year of the metaverse”, the concept of metaverse is promoting a multi-field innovation revolution on a global scale. The new experiences and technologies it brings are expected to provide solutions for the difficulties in the field of human visualization surgery in disease diagnosis, preoperative planning, surgical treatment, medical education, health management and patient experience. This opens up opportunities for the next wave of disruptive technology innovation. This paper proposes a new concept of “human visualization metaverse”, and summarizes its innovative application, future development direction and challenges to promote the research and development of human visualization metaverse,and to explore the application potential of metaverse technology in the field of surgery to advance the research and development of the metaverse for human visualization.

Throughout the 1 34-year development of hepatectomy,whether open,laparoscopic,or robotic,it has inherited an anatomical,empirical surgical approach based on morphology,which has not fundamentally changed the two-dimensional diagnosis and treatment of the disease.Over the last 20 years,the diagnosis and treatment of primary liver cancer have undergone profound changes with the advent and evolution of digital intelligent diagnosis and treatment technologies.Three-dimensional visualization techniques have allowed the pre-operative visualization of tumors and complex liver anatomy,changing the traditional two-dimensional diagnosis and treatment paradigm.The development of indocyanine green fluorescence imaging has enabled intraoperative visualization of tumor boundaries at the molecular and cellular levels.The application of augmented reality navigation technology has allowed the visualization of anatomical structures during surgery.Hepatectomy has transformed from traditional empirical surgery into modern intelligent navigation-based minimally invasive surgery,ushering in a new era of digital intelligent liver surgery.This review has summarized the most recent research progress of digital intelligent minimally invasive treatment of primary liver cancer.

Primary liver cancer(PLC)is one of the most common malignant diseases with the highest incidence and mortality rate,which poses a serious threat to public health in China.Thus,it is crucial to realize the early and accurate diagnosis of PLC.In clinical practice,traditional imaging techniques can provide the morphological information of liver cancer tissues,but they still have some limitations.Multimodality imaging can provide more comprehensive diagnostic information by integrating the advantages of different imaging technologies.By using liver cancer-specific targeting probes,multimodality imaging technology can achieve higher sensitivity and specificity than traditional imaging techniques.It can not only help with the accurate diagnosis of liver cancer by providing the structural and functional information of PLC simultaneously,but also guide surgeons to make better intraoperative decisions for PLC patients by supporting real-time navigation imaging during surgery.Therefore,multimodality imaging is of great significance to the clinical diagnosis and treatment of PLC.This review mainly focuses on the multimodality imaging technology and specific targeting probes of PLC,and summarizes the current research progress in this field.

Objective:To investigate the application value of augmented reality navigation combined with indocyanine green(ICG) fluorescence imaging technology in laparoscopic anatomical segment 8 liver resection.Methods:Clinical and pathological data from 8 patients with hepatocellular carcinoma located in segment 8 of the liver admitted to the First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University from October 2021 to October 2022 were collected restrospectively. Among them,there were 5 males and 3 females,aged between 40 and 72 years. During the operation,the self-developed laparoscopic augmented reality surgical navigation system was used to integrate the three-dimensional liver model with the laparoscopic scene,and ICG fluorescence imaging technology was used to guide the anatomical liver resection of segment 8. The predicted liver resection volume and actual liver resection volume,related surgical indicators and postoperative complications were analyzed.Results:Among the 8 patients, 4 underwent laparoscopic anatomical segment 8 liver resection,1 underwent laparoscopic anatomical ventral subsegment of segment 8 liver resection,2 underwent laparoscopic anatomical ventral subsegment combined with medial subsegment of segment 8 liver resection, and 1 underwent laparoscopic anatomical dorsal subsegment of segment 8 liver resection. All operations were completed under the guidance of augmented reality navigation combined with ICG fluorescence imaging,without conversion to open surgery. The operation time was (276.3±54.8)minutes(range:200 to 360 minutes). Intraoperative blood loss was (75.0±35.4)ml(range:50 to 150 ml). No blood transfusion was performed during the operation. The length of postoperative hospital stay was (7.6±0.8)days(range:7 to 9 days). There were no deaths or postoperative complications such as bleeding or biliary fistula during the perioperative period.Conclusion:Augmented reality navigation combined with ICG fluorescence imaging technology can guide the implementation of laparoscopic anatomical segment 8 liver resection.

Objective:To investigate the application value of augmented reality navigation combined with indocyanine green(ICG) fluorescence imaging technology in laparoscopic anatomical segment 8 liver resection.Methods:Clinical and pathological data from 8 patients with hepatocellular carcinoma located in segment 8 of the liver admitted to the First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University from October 2021 to October 2022 were collected restrospectively. Among them,there were 5 males and 3 females,aged between 40 and 72 years. During the operation,the self-developed laparoscopic augmented reality surgical navigation system was used to integrate the three-dimensional liver model with the laparoscopic scene,and ICG fluorescence imaging technology was used to guide the anatomical liver resection of segment 8. The predicted liver resection volume and actual liver resection volume,related surgical indicators and postoperative complications were analyzed.Results:Among the 8 patients, 4 underwent laparoscopic anatomical segment 8 liver resection,1 underwent laparoscopic anatomical ventral subsegment of segment 8 liver resection,2 underwent laparoscopic anatomical ventral subsegment combined with medial subsegment of segment 8 liver resection, and 1 underwent laparoscopic anatomical dorsal subsegment of segment 8 liver resection. All operations were completed under the guidance of augmented reality navigation combined with ICG fluorescence imaging,without conversion to open surgery. The operation time was (276.3±54.8)minutes(range:200 to 360 minutes). Intraoperative blood loss was (75.0±35.4)ml(range:50 to 150 ml). No blood transfusion was performed during the operation. The length of postoperative hospital stay was (7.6±0.8)days(range:7 to 9 days). There were no deaths or postoperative complications such as bleeding or biliary fistula during the perioperative period.Conclusion:Augmented reality navigation combined with ICG fluorescence imaging technology can guide the implementation of laparoscopic anatomical segment 8 liver resection.

In the era of medical big data, artificial intelligence is increasingly widely used in medicine. Efficient management and information mining of massive medical data can obtain useful information on disease development, progression, survival, and prognosis. In recent years, some achievements have been made in the application of artificial intelligence in primary liver cancer. This article elaborates on the current status and prospects of its application in the diagnosis and treatment of liver cancer.

Digital medicine has played a vital role in promoting the development of hepatobiliary and pancreatic surgery of China.The multidisciplinary integration of medical science and technology innovates research and development,and practice in clinical diagnosis and treatment.Digital medicine has enabled within 20 years,development from digital virtual human,three-dimensional visualization,molecular fluorescence imaging to artificial intelligence.There are four important stages of the development in China′s digital medical technology:digital medicine 1.0 (2002 to 2004,digital virtual human) on digital human anatomy, digital medicine 2.0(2004 to 2014,three-dimensional(3D) visualization and 3D printing) on 3D diagnosis and treatment of complex hepatobiliary and pancreatic diseases, digital medicine 3.0(2014 to 2019,molecular fluorescence imaging) on precision navigation of tumor boundaries and micro tumors using indocyanine green molecular imaging, and digital medicine 4.0(2019 to present,digital artificial intelligence) on augmented reality-based and mixed reality-based 3D abdominal navigation hepatectomy and photoacoustic imaging of tumors.Over the past 20 years′ course of development,Chinese researchers have made countless and remarkable achievements in digital medicine through continuous efforts and innovation. In the future,cutting-edge technologies such as artificial intelligence on deep machine learning,multi-mode image real-time fusion navigation surgery,photoacoustic imaging and targeted molecular probe technology will promote the development of digital medicine 4.0 in a coordinated manner,leading to the advent of digital medicine 5.0.

Digital medicine has played a vital role in promoting the development of hepatobiliary and pancreatic surgery of China.The multidisciplinary integration of medical science and technology innovates research and development,and practice in clinical diagnosis and treatment.Digital medicine has enabled within 20 years,development from digital virtual human,three-dimensional visualization,molecular fluorescence imaging to artificial intelligence.There are four important stages of the development in China′s digital medical technology:digital medicine 1.0 (2002 to 2004,digital virtual human) on digital human anatomy, digital medicine 2.0(2004 to 2014,three-dimensional(3D) visualization and 3D printing) on 3D diagnosis and treatment of complex hepatobiliary and pancreatic diseases, digital medicine 3.0(2014 to 2019,molecular fluorescence imaging) on precision navigation of tumor boundaries and micro tumors using indocyanine green molecular imaging, and digital medicine 4.0(2019 to present,digital artificial intelligence) on augmented reality-based and mixed reality-based 3D abdominal navigation hepatectomy and photoacoustic imaging of tumors.Over the past 20 years′ course of development,Chinese researchers have made countless and remarkable achievements in digital medicine through continuous efforts and innovation. In the future,cutting-edge technologies such as artificial intelligence on deep machine learning,multi-mode image real-time fusion navigation surgery,photoacoustic imaging and targeted molecular probe technology will promote the development of digital medicine 4.0 in a coordinated manner,leading to the advent of digital medicine 5.0.